001859 (SATT)44
P.O. BOX 1504 :No; 001859
Building 78-105 CALLE ESTADO
Address 54-362 Oak TWW LA QUINTA, CALIFORNIA 92253
Mailing
Address 7.5-005 COMItIV Cklb DxiVe
City Zip Tel.
Dec;art9=0 558-2328
Contractor
Naf ° I land and kO1, ^s.
Address .. ....
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PGk AST JMI3 Ot
` City... .._..
Q
Zip
>
Tel..
Sam
-
State Lic.
City
.1627
& Classif.-
Lic. # 3.28
Sq. Ft. . 42,E
Size
No. 1 No. Dw.
-.Stories Units
Arch., Engr. .. .
Designer
New•d Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
29715 • IRIBd HUI - M& .
MQ 540-5117
City
Zip
State
cbst3
9262ra
Lic. # _.
LICENSED CONTRACTOR'S DECLARATION..
hereby affirm that -Pam licensed under provisions of Chapter 9 (commencing with ,Section' .
7000) of Division.3 of the Business and Professions Code, and my license is iJull forcerand
effect' . ��, •' L %/,%�/� '.'
SIGNATURE' - 't " - / ! DATE
1%r OWNER•BUILDERDECLARATION'
l hereby affirm that I am exempt from the Contractor's. License Law for the following •
• • reason: (Sec: 7031.5,Business and Professions Code: Any -clty or county. which requires. a,
"permit. to construct, alter, improve, demolish, or repair any, structure; prior to its issuance also•
requires the applicant. for such permit to file a signed statement that .he is licensed pursuant to •-
the provisions of the Contractor's License Law, Chapter 9 (commencingwithSection 7000) or
Division 3 of the Business and' Professions Code, oR that. he is exempt therefrom,. and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty'of not more than five'hundred dollars' ($500).
❑ I, as owner of the property, or my. employees with wages as their sole compensation, will . ,
do the work, and the structure is not intended or offered for. sale. (Sec: 7044, Buisness and
Professions Code: The Contractor's License Law does not'apply to an owner of property who
builds or improves thereon and who does such work *himself or'through his own employees,
provided that' such improvements are not intended or offered for sale.- If, . however, the building .'
or improvement is sold within one year of completion, the owner -builder will have 'the burden
,. _. of proving that he did not build or improve for the purpose of sale.)' . ... .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's- License Law.
does not apply to an owner of property who builds or improves thereon, and who contracts for
Estimated Valuation .
103'0665.60
03 66 6I
+3 0 .6A
- - PERMIT.
- `AMOUNT
-
Plan Chk..Dep..
-
Plank Chk. Bal.*�3*t!
719
COr1St.,
4SY'..�W
Mech.
34,.00
Electrical
6f.g
.41
Plumbing
`750
_ .
S.M.I: -
- - %.18
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under -Sec. _.B. 8P.C. for this reason
Grading'
,
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I'hereby affirm that I have' a certificate of consent to self -insure, or a certificate' of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL
2,558.76
REMARKS
" CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of thg work for which this permit is issued, I shall not'
v�eons safer 9fa Ams rY� exTq �Pt
' ' - a AM. ��i KIM Jry O 'Has PUZISSAS .
-
- employ any person in any manner so as to become subject to -the Workers' Compensation'-
Laws of California.:
VMUAS
Date Owner `
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation *provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
, 'ZONE: BY:
Minimum Setback Distances: -
Front Setback from Center.LiIn
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY'
Side Street Setback from Center Line
' I hereby affirm that these is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line '
Lender's Name
Lender's .Address
FINAL DATE
Issued by:
,,Validated by:
Validation:
A 3 2 7 6
INSPECTOR
Date Permit
11 13 255&76 ft
This is a building permit when properly filled out, signed and validated; -and is subject to '
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that -the above information is correct. •-
I agree.td'comply'with all city and county ordinances and state laws relating to building
construction, and hereby authorize, representatives .�of'this city to enter the atiove-.
mentioned property for inspection°purposes.
Signature of applicant -'i�r' , -�. .' Date:&! /'`�.��.,
Mailing Address 1 r
_
City, State, Zip r''
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE2&k
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
CiS�
G
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING 3
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
`SEWER OR SEPTIgMW,,�p
{ROUGH WIRING 3 2
1 `METER
DUCT WORK
ROCK STORAGE
j^ FOUND. REINF. I�
CiS�
G
GAS (ROUGH)
LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
I IT REINF. STEEL �Lr
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING 3
FINAL INSP.
I (ROOFING G
o
/ e
`Y
REMARKS:
•
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
JkINSULATIONISOUND 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
fm p rc t w rAW-tom j, "z Y/ p r